Myth vs. Fact: Shades of darkness: Recognizing depression


If a loved one began to complain of blurred vision and tiredness, and scrapes to the skin seemed to take forever to heal, while trips to the bathroom to urinate were more frequent, would you suggest they see a doctor? These can all signs and symptoms of diabetes, which when untreated can lead to death.

What happens when someone losses energy, has trouble sleeping and no longer has interest in things they once enjoyed? What happens when a child never wants to get out of bed to go to school, or an adult often calls in sick from work? Is memory loss or difficulty focusing in an older person always a sign of dementia? These are all signs and symptoms of depression, which when untreated can lead to death.

According to the National Center for Health Statistics (April 2016) suicide rates increased between 1999 and 2014 by 24 percent. While we wouldn't tell anyone to, "pull yourself up by your boot straps," "get over it," or to "get a life," who has diabetes or any significant medical condition, we need to recognize depression as an equally serious and potentially life threatening illness that can be treated.

Depression, like diabetes, hypertension and other illnesses is an umbrella term under which are listed specific types. There are several symptoms and not all have to be present at the same time for depression to be the culprit. Some of the symptoms according to the Diagnostic Statistical Manual-5 include unexplained weight loss, weight gain, loss of interest in things previously found pleasurable, sense of emptiness or hopelessness, difficulty sleeping or sleeping too much, loss of energy, difficulty focusing, feeling worthless, and thoughts of wanting to die or of suicide.

The length of occurrence of certain symptoms can help to determine the type of depression a person is experiencing. Two weeks or more of some of the symptoms can be a sign of suffering from major depressive disorder, warranting medical attention. Depression stemming from premenstrual dysphoric disorder (PMDD) is associated with the menstrual cycle and is an example of a type of depression that can last for less than two weeks with each cycle, and like all forms of depression, can benefit from treatment.

Some diagnoses are associated with the possible cause of the symptoms. Perinatal depression (beginning before giving birth, and/or occurring after birth), seasonal affective disorder (occurring during the winter months — associated with a decrease in sunlight), or premenstrual dysphoric disorder (symptoms begin a week before menses begins — ending within days after its onset) are a few examples of diagnoses linked to particular situations.

Some disorders include other symptoms in addition to those of depression. Bipolar disorder is a blend of opposites involving periods of highly elevated and euphoric moods alternated with episodes of severe depression. The elevated moods are called hypomania or mania depending on their severity. The more severe symptoms (mania) can include intense energy decreasing ability to sleep, overspending, and indiscriminate sexual relations. People are less apt to desire help when they have boundless energy than they are when experiencing the depressive phase of the illness.

Depression knows no age limit, occurring in both children and adults. According to What You Need to Know: Depression, National Institutes of Mental Health (2015) some depressive characteristics in children may reveal themselves in irritability, pretending to be sick, or refusal to go to school. NIMH also describes a connection between "Most chronic mood disorders " and "high levels of anxiety in children."

Older individuals may experience tiredness, irritability, difficulty with sleep and confusion.

Some symptoms can mimic aspects of Alzheimer's disease, but are attributable to depression. There are medical conditions such as some thyroid disorders, and different medications attributable to symptoms of depression. The complexity of this disorder, and its impact on wellbeing requires regular screenings with thoughtful evaluation at doctor visits just as our blood sugar and cholesterol levels are checked yearly. The many facets of depression are too numerous to include in this article, nonetheless the information presented can serve as the basis for discussion of concerns with your medical provider.

Issues of bereavement and the various treatments for depression will be discussed in upcoming columns.

Carolyn Sacco, RN has worked as a nurse in psychiatry since 1985, in inpatient hospital, outpatient clinic, and home settings. Jeffrey Geller, MD. MPH is professor of psychiatry at the University of Massachusetts Medical School. He also treats in- and outpatients.


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